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. 2020 Dec 17;383(25):2417-2426.
doi: 10.1056/NEJMoa2019375. Epub 2020 Nov 11.

An Outbreak of Covid-19 on an Aircraft Carrier

Matthew R Kasper  1 , Jesse R Geibe  1 , Christine L Sears  1 , Asha J Riegodedios  1 , Tina Luse  1 , Annette M Von Thun  1 , Michael B McGinnis  1 , Niels Olson  1 , Daniel Houskamp  1 , Robert Fenequito  1 , Timothy H Burgess  1 , Adam W Armstrong  1 , Gerald DeLong  1 , Robert J Hawkins  1 , Bruce L Gillingham  1
Affiliations

An Outbreak of Covid-19 on an Aircraft Carrier

Matthew R Kasper et al. N Engl J Med. .

Abstract

Background: An outbreak of coronavirus disease 2019 (Covid-19) occurred on the U.S.S. Theodore Roosevelt, a nuclear-powered aircraft carrier with a crew of 4779 personnel.

Methods: We obtained clinical and demographic data for all crew members, including results of testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). All crew members were followed up for a minimum of 10 weeks, regardless of test results or the absence of symptoms.

Results: The crew was predominantly young (mean age, 27 years) and was in general good health, meeting U.S. Navy standards for sea duty. Over the course of the outbreak, 1271 crew members (26.6% of the crew) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by rRT-PCR testing, and more than 1000 infections were identified within 5 weeks after the first laboratory-confirmed infection. An additional 60 crew members had suspected Covid-19 (i.e., illness that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result). Among the crew members with laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop at any time during the clinical course. Among the 1331 crew members with suspected or confirmed Covid-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died. Crew members who worked in confined spaces appeared more likely to become infected.

Conclusions: SARS-CoV-2 spread quickly among the crew of the U.S.S. Theodore Roosevelt. Transmission was facilitated by close-quarters conditions and by asymptomatic and presymptomatic infected crew members. Nearly half of those who tested positive for the virus never had symptoms.

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Figures

Figure 1
Figure 1. Distribution of Personnel According to Case Status.
A confirmed case of coronavirus disease 2019 (Covid-19) was defined as one in which a nasopharyngeal swab specimen was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse-transcriptase polymerase chain reaction. A suspected case was defined as one that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result. Confirmed cases were further classified as symptomatic (with symptom onset before the first positive laboratory test), presymptomatic (with the first positive laboratory test before subsequent symptom onset), and asymptomatic (positive laboratory test but clinical criteria never met).
Figure 2
Figure 2. Numbers of Symptomatic Confirmed or Suspected Covid-19 Cases over Time.
Personnel, supplies, and mail are delivered to an aircraft carrier during carrier onboard delivery (COD).
Figure 3
Figure 3. Distribution of Symptomatic Confirmed or Suspected Covid-19 Cases According to Symptoms.
See this image and copyright information in PMC

Comment in

References

    1. Centers for Disease Control and Prevention. Lab advisory: updated instructions for use of CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel. 2020. (https://www.cdc.gov/csels/dls/locs/2020/updated_instructions_for_2019-nc...).
    1. CDC COVID-19 Response Team. Coronavirus disease 2019 in children — United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep 2020;69:422-426. - PMC - PubMed
    1. Earhart KC, Beadle C, Miller LK, et al. Outbreak of influenza in highly vaccinated crew of U.S. Navy ship. Emerg Infect Dis 2001;7:463-465. - PMC - PubMed
    1. Gonzaga VE, Ramos M, Maves RC, Freeman R, Montgomery JM. Concurrent outbreak of norovirus genotype I and enterotoxigenic Escherichia coli on a U.S. Navy ship following a visit to Lima, Peru. PLoS One 2011;6(6):e20822-e20822. - PMC - PubMed
    1. Kakimoto K, Kamiya H, Yamagishi T, Matsui T, Suzuki M, Wakita T. Initial investigation of transmission of COVID-19 among crew members during quarantine of a cruise ship — Yokohama, Japan, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:312-313. - PMC - PubMed

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